NPIMap

Organization Active NPI

Brazos Valley Community Action Agency, Inc.

  • Federally Qualified Health Center (FQHC)
  • Franklin, TX
National Provider Identifier
1184344657
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Practice address
317 N Owensville Street
RM #MC1
Franklin, TX 77856
Phone
(979) 977-5640
NPI assigned
Sep 2, 2022
Last updated
Jul 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Theresa Sabella, JD, PHD
Title
Ceo
Phone
(979) 383-2348

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

317 N Owensville Street
RM #MC1
Franklin, TX 77856

Mailing address

1500 University Dr E Ste 100
College Station, TX 77840-2600

Other names 1

  • HealthPoint SBHC Franklin Elementary Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221027002491 TX Part A Provider - Federally Qualified Health Center (FQHC) 4284542127 Practice locations: Franklin, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184344657. Details of each certification follow.

Federally qualified health center certification: CCN 971009

Legal name
BRAZOS VALLEY COMMUNITY ACTION AGENCY INC
Doing business as
SBHC - FRANKLIN ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2022
Last certification
Oct 20, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
317 N Owensville St
RM #MC1
Franklin, TX 77856

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Brazos Valley Community19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jennifer Mertz Individual Corporate OfficerChief Nursing Officer Jul 15, 2019 12%
Maryann Miyun Choi Individual Corporate OfficerChief Medical Officer Feb 5, 2024 12%
Theresa Sabella Individual Corporate OfficerChief Executive Officer Feb 15, 2021 25%
Operational/Managerial ControlChief Executive Officer Feb 15, 2021
Mike Sutherland Individual Corporate DirectorBoard Member Aug 12, 2010
Debra Makowsky Individual Corporate OfficerChief Human Resources Officer Feb 5, 2024 12%
W-2 Managing EmployeeAd; Feb 5, 2024
William Rios Individual Corporate DirectorBoard Member Jun 1, 2021
Mathew Woods Individual Corporate DirectorBoard Member Jun 1, 2021
Jacqueln Morrow Individual Corporate DirectorBoard Member Jun 1, 2021
Janie O Velasquez Individual Corporate DirectorBoard Member Apr 11, 2014
James McCullough Individual Corporate DirectorBoard Member May 10, 2012
Tasha de la Torre Individual Corporate DirectorBoard Member Jun 1, 2024
Carolyn Konecny Individual Corporate OfficerChief Financial Officer Aug 19, 2024 15%
Sally Guajardo Individual Corporate DirectorBoard Member Jun 1, 2023
Kimberley Usher Individual Corporate DirectorBoard Member Jul 12, 2017
Brian Thurston Individual Corporate OfficerChief Information Officer Feb 1, 2024 12%
Mary Wauters Individual Corporate OfficerChief Operations Officer Apr 4, 2022 12%
W-2 Managing Employee Apr 1, 2026
Laquita Clewis Individual Corporate DirectorBoard Member Sep 13, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1184344657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 UNIVERSITY DR E STE 100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778402600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 N OWENSVILLE STREET",
            "address_2": "RM #MC1",
            "city": "FRANKLIN",
            "state": "TX",
            "postal_code": "77856",
            "telephone_number": "979-977-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-02",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "SABELLA",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "979-383-2348",
        "authorized_official_credential": "JD, PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthPoint SBHC Franklin Elementary",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Franklin, TX

Sources for this page

Verify at the official NPI Registry.